Bottom Line:
The small intestine is the most commonly involved GI site, followed by stomach, colon, and esophagus.Synchronous plasmacytomas involving 2 anatomically distinct regions of gastrointestinal tract have never been reported in the literature.We report a case of a multiple myeloma patient who had acute-onset hematochezia and was found to have synchronous plasmacytomas of the colon and stomach.

Affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.

ABSTRACTGastrointestinal (GI) plasmacytomas, though relatively uncommon, can occur with or without multiple myeloma. The small intestine is the most commonly involved GI site, followed by stomach, colon, and esophagus. Synchronous plasmacytomas involving 2 anatomically distinct regions of gastrointestinal tract have never been reported in the literature. We report a case of a multiple myeloma patient who had acute-onset hematochezia and was found to have synchronous plasmacytomas of the colon and stomach.

Mentions:
Laboratory tests revealed serum calcium of 11.5 mg/dL, and an interval increase in serum M protein and kappa light chain, suggestive of multiple myeloma recurrence. While he was being treated for hypercalcemia, he had 3 episodes of bright red blood per rectum with a drop in hemoglobin from 9.3 g/dL to 6.8 g/dL. He had no abdominal pain, vomiting, or fever. He was hemodynamically stable with a heart rate of 94 beats/min and blood pressure of 130/84 mm Hg. His abdomen was soft and non-tender, with no palpable hepatosplenomegaly. Rectal exam revealed bright red blood in the rectal vault. Esophagogastroduodenoscopy (EGD) revealed a 1-cm sessile polyp in the body of stomach removed by snare polypectomy, and colonoscopy revealed a 5-cm ulcerated polypoidal mass in the ascending colon, which was biopsied (Figure 1). Pathological evaluation of both tissue specimens showed similar features, including an infiltrate of large neoplastic cells in the lamina propria with scant cytoplasm and prominent nucleoli (plasmablastic or high-grade morphologic features; Figure 2). Immunohistochemical stains showed CD138-positive cells with kappa light chain restriction, consistent with EMP (Figure 3). Congo red stain was negative for amyloid deposition. The patient was given 16 days of metronomic chemotherapy, but disease progressed despite therapy. The patient opted for palliative care and was discharged home with hospice care. He died at home 4 months later.

Mentions:
Laboratory tests revealed serum calcium of 11.5 mg/dL, and an interval increase in serum M protein and kappa light chain, suggestive of multiple myeloma recurrence. While he was being treated for hypercalcemia, he had 3 episodes of bright red blood per rectum with a drop in hemoglobin from 9.3 g/dL to 6.8 g/dL. He had no abdominal pain, vomiting, or fever. He was hemodynamically stable with a heart rate of 94 beats/min and blood pressure of 130/84 mm Hg. His abdomen was soft and non-tender, with no palpable hepatosplenomegaly. Rectal exam revealed bright red blood in the rectal vault. Esophagogastroduodenoscopy (EGD) revealed a 1-cm sessile polyp in the body of stomach removed by snare polypectomy, and colonoscopy revealed a 5-cm ulcerated polypoidal mass in the ascending colon, which was biopsied (Figure 1). Pathological evaluation of both tissue specimens showed similar features, including an infiltrate of large neoplastic cells in the lamina propria with scant cytoplasm and prominent nucleoli (plasmablastic or high-grade morphologic features; Figure 2). Immunohistochemical stains showed CD138-positive cells with kappa light chain restriction, consistent with EMP (Figure 3). Congo red stain was negative for amyloid deposition. The patient was given 16 days of metronomic chemotherapy, but disease progressed despite therapy. The patient opted for palliative care and was discharged home with hospice care. He died at home 4 months later.

Bottom Line:
The small intestine is the most commonly involved GI site, followed by stomach, colon, and esophagus.Synchronous plasmacytomas involving 2 anatomically distinct regions of gastrointestinal tract have never been reported in the literature.We report a case of a multiple myeloma patient who had acute-onset hematochezia and was found to have synchronous plasmacytomas of the colon and stomach.

Affiliation:
Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.

ABSTRACTGastrointestinal (GI) plasmacytomas, though relatively uncommon, can occur with or without multiple myeloma. The small intestine is the most commonly involved GI site, followed by stomach, colon, and esophagus. Synchronous plasmacytomas involving 2 anatomically distinct regions of gastrointestinal tract have never been reported in the literature. We report a case of a multiple myeloma patient who had acute-onset hematochezia and was found to have synchronous plasmacytomas of the colon and stomach.